Background: The timing of discharges of admitted patients has a significant impact on hospital efficiency and throughput. Earlier discharges are associated with improved boarding times, admissions arriving to inpatient units earlier in the day, and decreased length of stay. Discharges that occur later in the day creates a bottleneck effect, causing emergency room congestion, overcrowding, [...]

Background: The Cost Savings Reinvestment Program (CSRP) was created to benefit both the School of Medicine (SoM) and Stanford Health Care by incentivizing physicians to develop and assist with the implementation of initiatives that reduce hospital costs while maintaining or enhancing the quality of care provided to hospital patients. Cost savings realized from successful initiatives [...]

Background: Hospital medicine continues to expand and hospitalist practitioners are now rising to challenges of other venues looking to capture the value hospitalists bring. One area with a paucity of such skill but a rising need is the realm of eating disorder medicine. Purpose: To showcase hospital medicine in a niche role, specifically eating disorder [...]

Background: Approximately 20 million females and 10 million males in the United States have a clinically significant eating disorder at some point in their lifetime. In Western New York, comprising the three largest cities of Buffalo, Rochester and Syracuse, there are about 29,000 persons with eating disorders. Unfortunately , treatment for these medically fragile patients [...]

Background: There is growing adoption of Observation units as an answer to increasing payment denials in short stay admissions (ranging from 24-72 hours), overcrowding in emergency room, need for inpatient capacity and mismatched resource utilization. There is quite a bit of variation in the type of OBS units like Level I OBS unit- which is [...]

Background: While multiple organizations have recommended reducing unnecessary and repetitive lab tests in hospitalized patients, this has not resulted in a widespread change in behavior. There is agreement that unwarranted labs increase costs, but data around specific lab costs have not been readily available. At baseline, there were 125,586 labs ordered by the UNC Rex [...]

Background: The merging of academic and community hospitals into a single large healthcare system often does not account for the differences in health care delivery between sites, despite attempts by the system to streamline care through standardized policies, common metrics, and a shared medical record system. Multi-site service lines can be an effective strategy for [...]

Case Presentation: A 64 year-old man with a history of coronary artery disease status post 5-vessel coronary artery bypass grafting and subsequent percutaneous coronary intervention, essential hypertension, hyperlipidemia, and type 2 diabetes mellitus (DM) presented to the hospital with a 4 month history of chronic progressive abdominal pain and diarrhea with a 70 pound unintentional [...]

Case Presentation: Our patient is a 64 year old gentleman with a history of prior cerebellar stroke who presented to the Emergency Department (ED) after being found unresponsive in his car by bystanders. On ED evaluation he was noted to be lethargic, able to follow commands but unable to recall what happened. Neurologic exam in [...]

Case Presentation: A 64-year-old man with type 2 diabetes mellitus presented with three days of severe epigastric abdominal pain, vomiting, polyuria, and subjective dyspnea. Following the onset of illness, he stopped taking his home medications including insulin glargine and empagliflozin.Temperature was 97.5°F, heart rate 112 beats per minute, blood pressure 130/81 mmHg, respiratory rate 23 [...]